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*For Kaoutzanis ERAS DIEP Protocol, see the link to his page.
Admission Order
Admit: Chong (Unit: Stepdown)
Admit: Mathes (Unit: Stepdown)
Admit: Other (Unit: Stepdown)
Code Status
Full Code
Nursing Orders
Strict I&O, Every 4 hours
Weight patient on admit
Weigh patient every morning
Nursing Flap Checks and Vital Signs
PACU: Q15 minutes for 4 hours
POD#0: Q1H
POD#1: Q1H
POD#2: Q2H
POD#3: Q4H
Nursing Communications
Notify physician for increased swelling or color changes to flap
Notify physician for increasing redness or drainage from the wound
Notify physician for Vioptix parameter change by 15% or greater than baseline
Flow Coupler on at all times
Notify physician if there is a change in the sound of the venous coupler device
No Caffeine, Every Shift
Call physician for vital signs outside of normal ranges
Flexed at waist including for ambulation
No ice to breasts
Elevate head of bed to 30 degrees
Maintain Foley
BCIV with good PO intake
Telemetry monitoring
Continuous pulse oximetry
Incentive spirometer q1 while awake
Wean supplemental O2 as tolerated to keep sats above 88%
Neuro:
APAP 1g q6h PRN
Oxy 5mg q6h PRN
No toradol
PCA Dilaudid 0.2 q 10 min lockout
Discontinue PCA POD#2
Zofran IV q6 PRN
Ativan 1 mg q8 PRN
Pulm: IS, wean O2
CV: Hold home HTN medications POD#0
FEN/GI:
mIVF D5W-1/2NS+20KCl at 100cc/hr
POD#0, NPO, except medications
POD#1, CLD, no caffeine
POD#2, Reg, no caffeine
Colace sch BID
Miralax daily prn
GU:
Discontinue Foley on POD#1 if able to get OOB to chair
Heme:
POD#0 ASA suppository
POD#1: ASA 81 and Lovenox 40 mg qd if no concern for bleeding
ID: Periop ABX for 24 hours (Ancef, Clinda or Vanc)
Labs:
POD#1 CBC, BMP, Mg, Phos
Continue labs if patient remains NPO or discretion of resident
Activity Consults:
POD#0: Bedrest
PT/OT
Restrictions: BUE <5 lbs weight limit. No pushing or pulling. Okay to rest hands on walker for transfers and ambulation. Limit ROM of shoulders to 45 degrees abduction and extension, 90 degrees for flexion. Keep patient flexed at waist at approximately 30 degrees or greater, including while ambulating and transferring.
POD#1: OOB to chair
POD#2: Walk
Discharge:
Lovenox 40 qd for 2 weeks (prophylactic dosing- ASK. Cohen and Kaoutzanis do not send out with ppx Lovenox)
ASA 81 for 1 month
Pain Meds
Valium
No caffeine for 1 month (Cohen says caffeine is OK)
Order Set Name:
Physician Owner:
Nurse Owner: